Heat vs. Ice

miker_bioHeat vs. Ice?

This is one of the most common questions I am asked by patients. To complicate the matter, recent articles like the one that appeared in the Health Section of the New York Times on January 10th, 2012, titled “Why Ice May Not Be Good for Sore Muscles” may even further confuse people. This article raised some excellent points based on recent research about when, and more importantly, when it may not be good to use Ice.

When to use Heat

Heat can provide temporary relief of stiffness, relax muscles, and stimulate circulation. Heat increases tissue temperature and blood flow by dilating blood vessels, drawing extra nutrients into the area to assist in the recovery and healing process.

Heat therapy is most commonly applied with a moist hot pack, but can also be applied with whirlpools or paraffin baths.

When Not to use Heat

  • Heat should never be used on acute injuries until the swelling is controlled. Heat draws fluids into tissues and can increase swelling and inflammation. Do not use heat over swollen tissues or redness.
  • Do not use heat before vigorous exercise. Your muscles may be too relaxed to perform safely. (An active warm-up is a better option)

How to use Heat

  • Typical treatment times for heat applications are 15-20 minutes. It takes heat a minimum of 15 minutes to penetrate tissues to reach therapeutic temperatures.
  • Moist heat penetrates more deeply than dry heat and will not dehydrate tissues so circulation is improved.


  • Follow product instructions carefully.
  • Heat can burn and damage tissues if used improperly.
  • Do not use heat over areas of numbness or decreased sensation.

When to use Ice

Ice or Cold therapy is most often used for acute injuries. When applied immediately after an injury, cold treatment can reduce tissue damage and inflammation. Ice also relieves muscle spasms, and can reduce post-exercise soreness.

Cold therapy can be applied with ice packs, cold whirlpools, or cold sprays, but ice massage has been shown to be the most effective form of cold therapy.

When Not to use Ice

  • Do not use over areas of numbness or poor circulation.
  • Elderly people, young children, and people with diabetes must use caution with cold.
  • Recent research indicates impaired muscle strength and power immediately after icing, so it should not be used immediately before exercise or sports.

How to Use Ice

  • The first 72 hours after an acute injury, you should only use cold treatments.
  • Treatment time varies depending on several factors, including the size of the treatment area, the type of cold therapy applied, and the size of the individual.
  • For example, a thin person requires less treatment time because the cold does not need to penetrate through as much soft tissue.
  • You’ll know when you’ve had the cold on long enough, by monitoring the  4 stages of cold treatment:
    • Stage 1 is the obvious cold feeling
    • Stage 2 is a stinging or burning sensation
    • Stage 3 is aching
    • Stage 4 is numbness
  • It can take 5-15 minutes to reach all four stages.
  • Ice should be removed when numbness is reached.
  • For acute injuries, apply cold immediately for 10 to 20 minutes. Repeat the cold application 3-4x a day for the first 72 hours after an injury.
  • To reduce post-exercise soreness, apply cold immediately after exercise for 10 to 20 minutes.
  • For chronic discomfort, apply cold for a minimum of 10 minutes. Repeat as necessary.


  • Follow packaged instructions carefully.
  • Ice can burn or damage skin and tissues if used improperly.
  • Do not use Ice over areas of numbness or decreased sensation.

Most sources agree that alternating the use of heat and ice has not been shown to have any more benefit than applying ice or heat alone.

The above information has been commonly reported by a variety of sources, although new research is constantly challenging previous information. Please remember that if you have any questions about using Heat or Ice, you should consult your licensed healthcare practitioner.

Michael Racca, MSPT is a Licensed Physical Therapist in New York and Connecticut with over 10 years of diverse clinical and management experience in both hospital and outpatient settings. He has extensive experience working with clinic and in-home patients of a wide variety of diagnoses to help them restore their full potential level of function. He has given community lectures on a variety of topics including back education, total joint replacements, injury prevention, and sports performance. Mike has most recently specialized in treating the post-surgical orthopedic outpatient population and has helped many local students and nationally recognized athletes return to their prior level of competition following injury and surgery.
Elite Health Services, located in Old Greenwich, (and now Westport!) CT is a world-class provider of certified functional manual physical therapy, personal fitness, golf & triathlon performance training, massage therapy and wellness related services. Our team of highly skilled and dedicated professionals take a no-excuses approach to providing exceptional care and delivering exceptional results. To learn more visit www.EliteHealthServices.

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